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Humana Gold Plus H2486-005 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H2486-005 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H2486-005 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H2486-005 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in ID. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H2486-005 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus H2486-005 (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Gold Plus H2486-005 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $4.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Gold Plus H2486-005 (HMO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, for a standard pharmacy, you can expect to pay a $10 copay for preferred generic drugs, $47 for standard generic drugs, and 44% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H2486-005 (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services and emergency services have copays and/or coinsurance. Many services, such as primary care, vision, and dental services, have no copay. The plan covers essential services like home health and skilled nursing facilities, though some require prior authorization. Additionally, the plan includes benefits like ambulance services, hearing services, and medical equipment, each with its own cost structure. However, services like cardiac rehabilitation are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered under this plan. For Inpatient Hospital-Acute, you will pay a $510 copay for days 1-5, and no copay for days 6-90, with no coinsurance; for Inpatient Hospital Psychiatric, you will pay a $458 copay for days 1-5, and no copay for days 6-90, with no coinsurance.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a coinsurance of 20% and a copay between $0 and $520, while observation services have a copay of $510. Ambulatory surgical center services, individual and group substance abuse sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus H2486-005 (HMO) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H2486-005 (HMO) plan. Ground ambulance services have a $315 copay, while air ambulance services have a $1250 copay, and there is no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H2486-005 (HMO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $55 copay, with no coinsurance for either service. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The Humana Gold Plus H2486-005 (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $45 copay and no coinsurance, while physician specialist services have a $50 copay. Mental health specialty services and psychiatric services have no copay for individual and group sessions. Physical therapy and speech-language pathology services have a $45 copay and no coinsurance. Additional telehealth benefits have a copay between $0 and $55, and Opioid Treatment Program Services have a 20% coinsurance and no copay.
Preventive Services See details
The Humana Gold Plus H2486-005 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, are covered, but some services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services are covered by the Humana Gold Plus H2486-005 (HMO) plan, with a $50 copay for hearing exams, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $50, and eyewear with no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H2486-005 (HMO) plan covers Medicare Dental Services with a $50 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay, but with a 30-40% coinsurance for restorative services, 30% coinsurance for prosthodontics (removable and fixed). Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H2486-005 (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H2486-005 (HMO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), is covered by Humana Gold Plus H2486-005 (HMO), with an 8% coinsurance and no copay. Prosthetics/Medical Supplies and Diabetic Equipment are also covered, with varying coinsurance and copay amounts depending on the specific service.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures/tests have a minimum copay of $0 and a maximum copay of $55, while lab services have no copay. Diagnostic radiological services have a copay of at most $520, and therapeutic radiological services have a coinsurance of at least 20%. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H2486-005 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus H2486-005 (HMO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H2486-005 (HMO) plan, but require prior authorization. You will pay a $10 copay for days 1-20, a $214 copay for days 21-50, and no copay for days 51-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture and meal benefits. Acupuncture has a $50 copay and requires prior authorization, while the plan offers meal benefits with no copay, also requiring prior authorization.
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